Elderly heart valve patients have new life-saving option at Dominican

P1000235CAPITOLA—The first thing that 88-year-old Lee Fitzgerald noticed when he woke up from a surprisingly brief nonsurgical procedure to put a new valve in his heart was that the unremitting pain of angina that had limited his movement for the last year was gone. He could breathe better.

“When the operation was over, the first thing I felt was, ‘Oh God, there’s no pain,’” he said. “The chest pain was really confining. I couldn’t walk from one room to the next without pain.”

Fitzgerald, a retired accountant who lives in Capitola with his wife, Rosalee, was the first patient to undergo a transcatheter aortic valve replacement at Dignity Health Dominican Hospital earlier this year.

The procedure, a relatively new alternative to open heart surgery, is approved only for high-risk patients who are poor candidates for traditional surgery. Dominican is the only hospital on the Central Coast approved to conduct the procedure.

Dr. Shafi
Dr. Shafi

Since April, Fitzgerald and four other Santa Cruz County residents, two men and two women, each older than age 88, have had the procedure at Dominican and successfully recovered. Specialists at the hospital expect the numbers will grow once word spreads that it’s an option.

“If I hadn’t had that, I wouldn’t have lasted too long, maybe a year,” Fitzgerald said.

Indeed, the mortality rate of patients who begin to exhibit symptoms from severe aortic stenosis is poor.

“It’s basically a progressive disease where the valve between the heart and the body sticks and it makes it difficult for the heart to get blood out to the body,” said Neil Sawhney, an interventional cardiologist at Dominican.

Dr. Sawhney
Dr. Sawhney

Sawhney has been working closely with cardiothoracic surgeon Balil Shafi to prepare and train a specialized team to bring the procedure to Dominican. Severe aortic stenosis “is universally fatal if it’s untreated. The choice (for high-risk patients) has been open heart surgery or hospice.”

Epidemiological studies have determined that more than one in eight people aged 75 and older have moderate or severe aortic stenosis, according to independent research posted on the website of aortic valve manufacturer Edwards Lifesciences.

Up to 1.5 million people in the U.S. suffer from aortic stenosis. About one-third of these people suffer from severe aortic stenosis and about half of those, 250,000, are symptomatic, according to the University of Maryland Medical Center.

The Center reports that 50 percent of patients will not survive more than an average of two years after the onset of symptoms without an aortic valve replacement

In transcatheter aortic valve replacement, the surgeon attaches a replacement heart valve to a balloon and inserts the balloon into the body via catheter through a patient’s leg or chest while the patient is under general anesthesia. The new valve is positioned inside the faulty aortic valve and the balloon is inflated, precisely positioning the replacement valve. The procedure leaves only a small incision in the groin or side. Typical recovery time is three to five days.

“That beats the hell out of chest surgery,” Fitzgerald said, noting that although he was aware of the insertion site, he didn’t feel any discomfort two days after surgery.”

The procedure, approved by the U.S. Food and Drug Administration in 2011, is not authorized for younger, relatively healthy people who can expect good results from a more traditional surgical option. But, transcatheter aortic valve replacement doctors at Dominican say it is ideal for elderly people with complex medical conditions who might not survive the more invasive open heart surgery and months of post-op recovery.

“It’s a heartbreaking choice,” Sawhney said. “For those people, the TVAR is a complete lifesaver.”

Having the procedure in their hometown means elderly and frail patients who can’t travel over the hill for treatment can be nearer to family as well.

Most important, the procedure is an opportunity for patients to live a better life, Shafi said.

On Father’s Day, Fitzgerald had lunch with two of his daughters at the Crow’s Nest. Although he’s had some other medical challenges that affect his back and balance, he has returned to the golf course driving range.

“I’m terrible, but I’m there,” he said.

Although hailed as one of the biggest advances in cardiac surgery in recent years, University of Pennsylvania medical researchers reported in January that hospital marketing often fails to adequately state the actual risks associated with the procedure.

Common risks associated with the procedure include stroke, vascular complications, an unknown long-term valve durability and death.

“We do a lot of planning before putting these valves in,” Shafi said, noting that the aortic valve is measured through imaging and again in the operating room.

Medical advancements have been so rapid it’s difficult to predict what the procedure could look like in the future.

EdwardsLIfesciencesSapienxt_expanded“In next five to 10 years, we may learn so much that open surgical procedures become a thing of the past,” Shafi said.

Last year, University of Pennsylvania reported that patients who undergo a new valve replacement procedure that involves no incision at all, just a pin-prick to access the femoral artery have even shorter hospital stays. They leave the hospital with little to no trace that a surgery was performed.

This is the first of many new offerings people can expect from Dominican, Shafi said, noting months of preparation and training to meet rigorous national standards to provide the procedure.

Cardiologists in the community are increasingly hearing about the program and working with the Dominican team, he said.

“We’re expanding a number of things including offering treatment for aortic diseases for patients that are in acute cardiogenic shock and pulmonary failure due to the flu,” Shafi said. “We’re in the process of building a program here where we can support all the pulmonary diseases we can and not have to ship any of our patients out.”

Transcatheter Aortic Valve Replacement

ABOUT AORTIC STENOSIS: Severe aortic stenosis is a narrowing of the aortic valve opening that does not allow normal blood flow. In elderly patients, aortic stenosis is often caused by the buildup of calcium (mineral deposits) on the aortic valve’s leaflets. This buildup of calcium on the leaflets impairs the aortic valve’s ability to fully open and close. Symptoms include shortness of breath, fatigue, chest pain.

HISTORY OF TAVR: Penn Medicine, University of Pennsylvania Health System, was one of the first sites in the country to participate in trials to use and test the valve in 2007. The TAVR procedure was approved by the FDA in November of 2011

THIS MONTH: Both Edwards Lifesciences Corp. and Medtronic PLC received FDA approvals for their newest, most advanced TVAR devices.

THE VALVE: http://www.edwards.com/products/transcathetervalve/Pages/THVcategory.aspx

Source: University of Pennsylvania’s Penn Medicine FAQ

This article first appeared in the Santa Cruz Sentinel.

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